BACKGROUND/AIMS: Reflux esophagitis is a recurring condition for which many patients require maintenance therapy. This comparative, randomized multicenter study was designed to evaluate the effect of long-term maintenance treatment comparing proton pump inhibitor, rabeprazole and H2 receptor antagonist, ranitidine. METHODS: Eighty four patients with healed reflux esophagitis confirmed by endoscopy were randomly allocated to receive maintenance treatment with either rabeprazole 10 mg once daily or ranitidine 300 mg once daily for 32 weeks. Patients were seen every 8 weeks or at symptomatic relapse. RESULTS: Of 84 initially treated patients, 73 entered the maintenance study. The percentage of asymptomatic patients after 90-day and 210-day treatment were 97% and 81.5%, for rabeprazole and 74.3% and 62.3%, for ranitidine, respectively. After 32 weeks, the relapse rates of esophagitis were 21.3% in the rabeprazole group and 62.9% in the ranitidine group (RR: 0.405, 95% CI: 0.215-0.766). CONCLUSIONS: Maintenance treatment with rabeprazole (10 mg once daily) is superior to ranitidine (300 mg once daily) in keeping the patients with reflux esophagitis in remission over a 32 week period.
2-Pyridinylmethylsulfinylbenzimidazoles ; Adult ; Anti-Ulcer Agents/*therapeutic use ; Benzimidazoles/*therapeutic use ; Esophagitis, Peptic/*drug therapy ; Female ; Humans ; Male ; Middle Aged ; Omeprazole/*analogs & derivatives/therapeutic use ; Ranitidine/*therapeutic use

OBJECTIVETo observe the effect of pungent dispersion bitter purgation method (PDBPM) on the esophageal mucosal intercellular space of reflux esophagitis (RE) model rats.

METHODSTotally 100 Wistar rats were randomly divided into the control group, the model group, the Western medicine group (WM), the Chinese medicine group (CM), 25 rats in each group. Rats in the control group only received switch operation. Rats in the rest three groups received modified partial cardia muscle incision combined pylorus ligation of external parts to prepare the RE rat model. Starting from the 3rd day after operation, WM mixture (Motilium 3. 2 mg/kg + Omeprazole Capsule 4.3 mg/kg + Hydrotalcite Tablet 161.4 mg/kg) was administered by gastrogavage to rats in the WM group. Rats in the CM group was administered by gastrogavage with Modified Banxia Xiexin Decoction (5.7 g/kg), 2.5 mL each time, twice daily for 14 consecutive days. Equal volume of normal saline was administered by gastrogavage to rats in the control group and the model group. On day 7 and 14, the lower esophagus pH value, general specimen of mucosa and histopathologic changes were observed. Intercellular spaces of esophageal epithelium were measured for a control study.

RESULTSCompared with the same group at day 7, the lower esophagus pH value increased at day 14 (P < 0.01); the naked eye integral of esophageal mucosa and intercellular spaces of esophageal epithelium also decreased at day 14 in the CM group and the WM group (P < 0.05). Compared with the control group at the same time point, the lower esophagus pH value decreased in the model group (P < 0.01). The naked eye integral of esophageal mucosa, and intercellular spaces of esophageal epithelium increased in the model group with increased intercellular spaces (P < 0.01). Compared with the model group at the same time point, the lower esophagus pH value increased and the naked eye integral of esophageal mucosa decreased in the CM group and the WM group at day 7 and 14 (P < 0.01). Intercellular spaces of esophageal epithelium of RE model rats at day 14 was lower in the CM group and the WM group than in the model group (P < 0.01). Compared with the WM group, the lower esophagus pH value decreased at day 7 in the CM group (P < 0.05); the naked eye integral of esophageal mucosa and intercellular spaces of esophageal epithelium decreased at day 14 in the CM group (P < 0.05).

CONCLUSIONSPDBPM had favorable treatment effect on RE model rats. The therapeutic effect was more obvious along with the therapeutic course went by. Its mechanism might be achieved through good repair effect on damaged mucosa, increasing the pressure of esophageal sphincter, and inhibiting gastric acid.

Animals ; Anti-Ulcer Agents ; pharmacology ; therapeutic use ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Esophagitis, Peptic ; drug therapy ; Extracellular Space ; Mouth Mucosa ; Omeprazole ; therapeutic use ; Rats ; Rats, Wistar

OBJECTIVE: To compare the clinical effect on gastroesophageal reflux asthma between the needling technique of acupuncture (acupuncture for promoting the circulation of the governor vessel and reducing the reversed ) and omeprazole enteric capsules (OME). METHODS: A total of 60 patients with gastroesophageal reflux asthma were randomized into an acupuncture group and a western medication group, 30 cases in each one. The basic treatment for anti-bronchial asthma was provided in both of the groups. Additionally, OME was prescribed for oral administration in the western medication group, twice a day, 20 mg each time, for 8 weeks. In the acupuncture group, the needling technique of acupuncture was added. The needles were inserted at the sites inferior to the spinous processes of T to T. Acupuncture was given once in the morning on Tuesday, Thursday and Saturday respectively, totally for 8 weeks. Separately, before and after treatment, the score of reflux disease diagnostic questionnaire (RDQ), the score of asthma control test (ACT) and the tenderness threshold at the sites inferior to the spinous processes of T to T were observed and the clinical effect was evaluated in the two groups. RESULTS: ①The remarkably effective and curative rate was 46.7% (14/30) in the acupuncture group, higher than 3.3% (1/30) in the western medication group (<0.01). The asthma control rate was 66.7% (20/30) in the acupuncture group, higher than 13.3% (4/30) in the western medication group (<0.01). ②RDQ score after treatment was lower than that before treatment in either group (<0.05). The decrease range of RDQ score in the acupuncture group was larger than that of the western medication group (<0.05). After treatment, ACT score was increased as compared with that before treatment in either group (<0.05) and the increase range of ACT score in the acupuncture group was larger than that of the western medication group (<0.05). ③The tenderness thresholds at the sites inferior to the spinous processes of T to T and T to T were all increased after treatment as compared with those before treatment in the acupuncture group separately (<0.05). In the western medication group, the thresholds were only increased at the sites inferior to the spinous processes of T, T and T after treatment as compared with those before treatment separately (<0.05). After treatment, the tenderness thresholds at T to T in the acupuncture group were all higher than the western medication group (<0.05). CONCLUSION The needling technique of acupuncture effectively relieves the symptoms of gastroesophageal reflux asthma and improves the quality of life in the patients and its effect is better than omeprazole enteric capsules.
Acupuncture Points ; Acupuncture Therapy ; Asthma ; therapy ; Gastroesophageal Reflux ; therapy ; Humans ; Omeprazole ; therapeutic use ; Quality of Life ; Treatment Outcome

OBJECTIVEDiagnosing asthma in infancy is largely made on the basis of the symptoms of cough and wheezing. A similar presentation can be seen in neurologically normal infants with excessive gastroesophageal reflux (GER). There are no randomized placebo controlled studies in infants using proton pump inhibitors (PPI) alone or in addition to prokinetic agents. The primary objective was to confirm the presence of excessive GER in a population of infants that also had respiratory symptoms suggestive of asthma. Second, in a randomized placebo-controlled fashion, we determined whether treatment of GER with bethanacol and omeprazole could improve these respiratory symptoms.

METHODSInfants (n=22) with a history of chronic cough and wheeze were enrolled, if they had evidence of GER by history and an abnormal pH probe or gastric emptying scan. Infants were randomly allocated to four treatment groups: placebo/placebo (PP), omeprazole plus bethanacol (OB), omeprazole/placebo (OP), bethanacol/placebo (BP). Evaluations by clinic questionnaire and exam, home diary, and pH probe data were done before, after study-medication and after open label of OB.

RESULTSNineteen children were studied. PP did not affect GER or respiratory symptoms, and did not decrease GER measured by pH probe. In contrast, OB decreased GER as measured by pH probe indices and parental assessment. In association, OB significantly decreased daytime coughing and improved respiratory scores. No adverse effects were reported.

CONCLUSIONSIn infants with a clinical presentation suggestive of chronic GER-related cough, the use of omeprazole and bethanacol appears to be viable therapeutic option.

Bethanechol ; therapeutic use ; Cough ; drug therapy ; Double-Blind Method ; Female ; Gastroesophageal Reflux ; complications ; Humans ; Hydrogen-Ion Concentration ; Infant ; Male ; Omeprazole ; therapeutic use ; Pilot Projects ; Respiratory Sounds ; etiology

OBJECTIVETo explore the diagnostic values of 24-hour pH monitoring in patients with laryngopharyngeal reflux disease (LPRD).

METHODSFifty patients with suspected laryngopharyngeal reflux were enrolled into this study. Twenty five patients had 24-hour pH monitoring, antacid treatment with omeprazole was given in study group with pathologic reflux. The remaining 25 patients as control group only had the same antacid treatment. All the patients had 3 months follow up, and treatment effect was evaluated according to clinical manifestation improvement. After 3 month treatment followed up, it was defined as inefficacy treatment if the clinical manifestation score decrease was equal or less than 4, defined as efficacy if the score decrease was more than 4.

RESULTSSeventeen of 25 patients had pathologic reflux, positive rate was 68.0%. The mean times of total acid reflux was 35.71 +/- 41.70 (x +/- s), the mean total reflux time was (35.71 +/- 33.19) min, the mean total reflux index (reflux times per hour) was (1.53 +/- 1.73)/h, the mean reflux time was (1.12 +/- 0.91) min. Before antacid treatment, the mean clinical manifestation score was 14. 88 +/- 4.11 in study group and 13.00 +/- 4.17 in control group. There was no significant difference between the two groups (t = 1.444, P > 0.05). The validity of study group was 82.4% (14/17), Among the control group, two cases were out of followed, and the validity of remained patients was 52. 2% (12/23). The mean decreased score of clinical manifestation in study group was 7.47 +/- 3.18 and 3.96 +/- 4.25 in control group. There was significant difference between the two groups (t = 2. 864, P = 0.007).

CONCLUSIONSThe dual-probe 24-hour pH monitoring is considered the gold standard for diagnosis of LPRD and it is essential in patients who have laryngopharyngeal complaints and is capable to improve the effect of antacid treatment significantly. It's worthy of clinical application.

Adult ; Aged ; Antacids ; therapeutic use ; Esophageal pH Monitoring ; Female ; Humans ; Laryngopharyngeal Reflux ; diagnosis ; drug therapy ; physiopathology ; Male ; Middle Aged ; Omeprazole ; therapeutic use ; Pharynx ; physiopathology ; Young Adult

BACKGROUNDOmeprazole, usually used in the antiplatelet therapy during percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS), has been reported to increase ischemic events in retrospective studies. However, other clinical trials gave paradoxical results. The aim of this study was to assess the effects of omeprazole on clopidogrel efficacy and clinical events.

METHODSAll patients (n = 172) received aspirin (loading dose 300 mg and maintenance dose 100 mg/d) and clopidogrel (loading dose 600 mg and maintenance dose 75 mg/d) during the therapy. They were randomized to receive omeprazole (20 mg/d) or placebo for 30 days. Residual platelet activities in the adenosine 5'-diphosphate (ADP) pathway were detected on the fifth day after PCI with thrombelastography (TEG)-mapping. The clinical events were recorded after one month.

RESULTSAccording to the five levels of platelet activities, the frequency distributions of the inhibition rates were significantly different (P = 0.0062). However, no significant change was seen in the distribution among the highest or the lowest inhibiting levels (> 95% and < 30% inhibition rate). And there were no significant differences (P > 0.05) in events incidence, while gastro-intestinal bleeding decreased in co-administration of omeprazole.

CONCLUSIONSOmeprazole significantly blunts clopidogrel efficacy while not exacerbates ischemic events in ACS undergoing PCI. Omeprazole even can decrease gastro-intestinal bleeding in those patients.

Acute Coronary Syndrome ; blood ; drug therapy ; pathology ; therapy ; Aged ; Angioplasty, Balloon, Coronary ; methods ; Aspirin ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Omeprazole ; therapeutic use ; Platelet Aggregation Inhibitors ; therapeutic use ; Ticlopidine ; analogs & derivatives ; therapeutic use

BACKGROUND/AIMS: It is not clear whether the anti-secretory therapy should be continued for symptomatic relief and ulcer healing before or after the eradication of H. pylori in patients with peptic ulcer disease. The aim of this study was to evaluate the effectiveness of additional anti-secretory therapy before or after H. pylori eradication in peptic ulcer disease. METHODS: Thirty eight patients with H. pylori-positive active peptic ulcer were included. Patients were randomly allocated into 3 groups; standard 1-week triple therapy followed by omeprazole (20 mg, qd) for 3 weeks (group A), standard 1-week triple therapy only (group B), and omeprazole (20 mg, qd) for 3 weeks followed by 1-week triple therapy (group C). Endoscopy with the rapid urease test and histology for H. pylori was performed 4-8 weeks after the completion of treatment. The symptom was scored by a visual analog scale. RESULTS: Of the 38 patients, 10 were excluded from the per-protocol analysis of this study. The H. pylori eradication rates were 87.5% (group A), 80.0% (group B) and 90.0% (group C) respectively. The peptic ulcer healing rates were 100% in group A, 70.0% in group B, and 90.0% in group C. There was no difference in H. pylori eradication rates and ulcer healing rates among three groups (p>0.05). Symptom score differences between pre-treatment and post-treatment group were not significantly different (p>0.05). CONCLUSIONS: The standard one week triple therapy with or without 3-weeks anti-secretory treatment with omeprazole before or after the therapy does not affect H. pylori eradication rates, peptic ulcer healing rates, and symptom score improvement.
Adult ; Anti-Bacterial Agents/administration & dosage/therapeutic use ; Anti-Ulcer Agents/administration & dosage/*therapeutic use ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Omeprazole/administration & dosage/therapeutic use ; Peptic Ulcer/*drug therapy/microbiology

OBJECTIVETo observe the histological changes of gastric mucosa in patients with active gastric ulcer before and after treatment by Qifang Weitong Powder combined with omeprazole (QWP-Op).

METHODSSixty patients were equally randomized into the treated group and the control group. They were all treated in the 1st week by the Helicobacter pylori eradication triad regimen. From the 2nd to 6th week, the study group re-ceived QWP-Op therapy, and the control group was given Omeprazole alone.Biopsy specimens were obtained around ulcer area before and after treatment for histological observation on changes of gastric mucosa membrane.

RESULTSThe improvement of mucosal thickness and glandular morphology was better in the treated group than that in the control group (P <0.05).

CONCLUSIONQWP-Op therapy can improve the histological quality of ulcer healing and restore the morphological structure of gastric mucosa in patients with active gastric ulcer.

Adult ; Anti-Ulcer Agents ; therapeutic use ; Biopsy, Needle ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gastric Mucosa ; pathology ; Humans ; Male ; Middle Aged ; Omeprazole ; therapeutic use ; Phytotherapy ; Powders ; Stomach Ulcer ; drug therapy ; pathology ; Treatment Outcome ; Young Adult

OBJECTIVETo study the effect of yiqi huoxue formula (YHF) on healing and recurrence of peptic ulcer.

METHODSAdopting randomized and controlled principle, the 46 patients with active peptic ulcer were randomly allocated into the treated group and the control group, they received respectively the treatment of YHF + Omeprazole and Omeprazole alone for 5 weeks. If exhibiting positive Hp, the Trigeminy one-week eradicating treatment, using Omeprazole, Clarithromycin and Amoxicillin, was applied firstly, after then, followed with the prescriptive treatment. Gastroscopy was performed before and after treatment to assess the status of Hp eradicating and the endoscopic and histological maturity of regenerated mucosa. Meanwhile, the changes of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) levels were detected with ELISA. Patients with ulcer healed were followed up for 6 months to observe the condition of recurrence.

RESULTSThe percentage of Sc phase maturity and excellent histological maturity of regenerated mucosa obtained in the treated group were more than those in the control group respectively (P < 0.05), and levels of VEGF and bFGF increased significantly in the treated group after treatment (P < 0.05). But the difference of ulcer recurrence rate between the two groups in the 6-month follow-up study showed no statistically significance. However, the recurrence rate in patients with excellent histological maturity of regenerated mucosa was lower than that with good histological maturity (P < 0.05); and it was decreasing along with the progressing of regenerated mucosa endoscopic maturity, i.e., Sc < Sb < Sa (P < 0.01).

CONCLUSIONYHF can improve the quality of ulcer healing, and its mechanism is possibly related to the increase of VEGF and bFGF expressions. The higher the quality of ulcer healing, the lower the recurrence rate.

Adult ; Anti-Ulcer Agents ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Fibroblast Growth Factor 2 ; metabolism ; Humans ; Male ; Middle Aged ; Omeprazole ; therapeutic use ; Peptic Ulcer ; drug therapy ; pathology ; Phytotherapy ; Recurrence ; Vascular Endothelial Growth Factor A ; metabolism

BACKGROUND/AIMS: The eradication rates of Helicobacter pylori infection have been reported to have decreased over the years due to antibiotics resistance. The aim of this study is to investigate the trend of eradication rates of first-line triple therapy for H. pylori over the past 13 year period, and to evaluate factors affecting H. pylori eradication in Daegu and Gyeongsangbuk-do, Korea. METHODS: A total of 2,982 patients with H. pylori infection who were treated with either 1 week or 2 weeks first-line therapy (proton pump inhibitor [PPI], amoxicillin, and clarithromycin) from January 1999 through December 2011 were included in this study. Data were collected by retrospectively reviewing the medical records. RESULTS: The overall H. pylori eradication rate was 87.2%. The eradication rates from 1999 to 2011 fluctuated between 78.0% and 95.7%, but no definite evidence of a decreasing tendency was seen over the 13 year period (p=0.113). Furthermore, there was no significant difference in the eradication rate according to the duration of therapy (p=0.592). However, there was a significant difference in the eradication rate among various PPIs (p<0.01). CONCLUSIONS: There was no decreasing trend in the H. pylori eradication rate over the past 13 years in Daegu and Gyeongsangbuk-do, Korea. There also was no difference in the eradication rates depending on duration of therapy. However, a significant difference was noted among various PPIs.
Adult ; Aged ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/*therapeutic use ; Clarithromycin/therapeutic use ; Disease Eradication/*trends ; Drug Administration Schedule ; Drug Therapy, Combination ; Endoscopy, Gastrointestinal ; Esomeprazole/therapeutic use ; Female ; Helicobacter Infections/*drug therapy/pathology ; *Helicobacter pylori ; Humans ; Logistic Models ; Male ; Middle Aged ; Omeprazole/therapeutic use ; Proton Pump Inhibitors/*therapeutic use ; Rabeprazole/therapeutic use ; Republic of Korea ; Retrospective Studies ; Treatment Outcome